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The survival after thyroidectomy versus lobectomy in multifocal papillary thyroid microcarcinoma patients

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Abstract

Background

The extent of thyroid surgery for multifocal papillary thyroid microcarcinoma (PTMC) remains controversial. Studies on the optimal surgical approach for a multifocal PTMC are scarce. This study aimed to compare the effectiveness of thyroidectomy and lobectomy for the treatment of multifocal PTMC.

Methods

A population-based retrospective cohort of patients with multifocal PTMC was analyzed using the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2017, and divided into two groups (thyroidectomy, lobectomy) based on the surgical approach. The clinicopathologic features and survival outcomes were compared between the two groups. Cox proportional hazards regression analysis to explore prognostic factors of survival. Propensity score matching (PSM) was used to balance covariates.

Results

Overall, a total of 9387 multifocal PTMC patients were included in the study. Among them, 8,107 (86.36%) patients received thyroidectomy, and 1280 (13.64%) patients underwent lobectomy. Compared to patients in the thyroidectomy group, patients in the lobectomy group were diagnosed with older age (50.47 years vs. 49.32 years, p = 0.003), a higher proportion of males (20.47% vs. 14.99%, p < 0.001), larger tumors (6.22 mm vs. 4.97 mm, p < 0.001), and more frequently underwent radiotherapy (35.40% vs. 10.16%, p < 0.001). Multivariate Cox regression analysis revealed that age was the only independent prognostic factor for thyroid cancer-specific survival (TCSS), and the determinants of overall survival (OS) were age and gender. Unadjusted survival analysis revealed no difference between the two treatment groups in TCSS (p = 0.598) and OS (p = 0.126). After 1:1 Propensity Score Matching (PSM), there was still no difference in TCSS (p = 0.368) or OS (p = 0.388). The stratified analysis revealed that for patients aged under or above 55, thyroidectomy was not associated with superior BCSS or OS (p > 0.05).

Conclusions

Thyroidectomy was not associated with improved survival compared to thyroid lobectomy for patients with multifocal PTMC.

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Data availability

The SEER data set used in this publication is owned by the National Cancer Institute. Interested party can apply for access from the National Cancer Institute (https://seer.cancer.gov/data/access.html). The data analysed in the current study are available from the corresponding author on reasonable request.

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Author notes

  1. These authors contributed equally: Xiang Ai, Kongyong Zhang

Authors and Affiliations

  1. Department of Thyroid and Breast Surgery, The General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China

    Xiang Ai, Juan Xu, Hualin Xiao, Lingfan Li & Peng Sun

  2. Breast Disease Center, Southwest Hospital, the Army Military Medical University, Chongqing, 400038, China

    Kongyong Zhang

  3. Department of Thyroid and Breast Surgery, Chengdu Fifth People’s Hospital, The Fifth People’s Hospital Affiliated to Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, 611130, China

    Junyan Li

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Contributions

X.A. designed the study, performed further data analysis, and drafted the manuscript. K.Z. and Y.X. interpreted the data and assisted in writing. L.L. and L.X. assisted in writing and revising the manuscript. J.L. and P.S. performed data extraction and initial analysis. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Peng Sun or Junyan Li.

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The authors declare no competing interests.

Ethics

This study was performed in accordance with the Helsinki Declaration of 1964, and its later amendments. This retrospective study was reviewed and approved by the Ethics Committee of The General Hospital of Western Theater Command. For this type of study informed consent is not required. No human participants or human tissue involved in this study.

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Ai, X., Zhang, K., Xu, J. et al. The survival after thyroidectomy versus lobectomy in multifocal papillary thyroid microcarcinoma patients. Endocrine (2024). https://doi.org/10.1007/s12020-024-03794-4

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